Rcpc Form A-8 Agreement To Pay Expenses
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1PROBATE COURT OF RICHLAND COUNTY, OHIO
PLACEMENT OF
(Name before placement)
CASE NO.
AGREEMENT TO PAY EXPENSES
R.C. 5103.16 (C), R.C. 3107.10 (B)
We,
and
being husband and wife, do hereby agree this
day of
,
,
that by seeking placement for adoption of a child that we are liable to pay
the following expenses, REGARDLESS OF THE OUTCOME OF THE PLACEMENT OR
ADOPTION, as provided in Section 3107.10 of the Ohio Revised Code:
1)
Physician expenses incurred on behalf of the birth mother or minor in the
connection with prenatal care, delivery and confinement prior to or following
the minor’s birth.
2)
Hospital or other medical facility expenses incurred on behalf of the
birth mother or minor expenses incurred in connection with the birth of the
minor to be adopted
3)
Agency expenses incurred for providing services in connection with the
adoption or in connection with placement services provided by an agency under
Section 5103.16 of the Ohio Revised Code.
4)
Temporary cost of routine maintenance and medical care for a minor
required under R.C. 5103.16, if we refuse to accept placement of the minor.
Said service to be in a hospital, foster home or other appropriate place for
up to thirty days or until other coustody is established for the minor,
whichever is less.
5) Reasonable counseling expenses for the parents of the child.
We further agree to pay attorney’s fees incurred in providing legal
services in connection with the placement of the minor to be adopted and in
connection with legal services provided to initiate and pursue the adoption
proceedings.
Attorney for Prospective Adoptive
Husband
Parents
Typed or Printed Name
Typed or Printed Name
Attorney Registration Number
Wife
Date:
Typed or Printed Name
RCPC FORM A-8 AGREEMENT TO PAY EXPENSES
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